Download PDF
Thorac Cardiovasc Surg 2021; 69(01): 013-018
DOI: 10.1055/s-0039-3400263
Original Cardiovascular

Training of Residents in Cardiac Surgery—Does It Have Impact on the Outcome?

Marcin Piotr Szczechowicz 
1   Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg, Groningen, Oldenburg, Germany
,
Jerry Easo 
1   Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg, Groningen, Oldenburg, Germany
,
Konstantin Zhigalov
1   Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg, Groningen, Oldenburg, Germany
,
Ahmed Mashhour
1   Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg, Groningen, Oldenburg, Germany
,
Sabreen Mkalaluh
1   Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg, Groningen, Oldenburg, Germany
,
Alexander Weymann
1   Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg, Groningen, Oldenburg, Germany
› Author Affiliations
› Further Information
    Permissions and Reprints All articles of this category

Abstract

Objectives In many centers, training in cardiac surgery is considered to increase perioperative risk. This study aims to test whether a resident working as the main operator is a genuine risk factor.

Methods We analyzed patients who underwent elective isolated aortic valve replacement, elective isolated coronary artery bypass grafting, or both, in our institution, from 2008 to 2016. Redo- and off-pump surgery, ejection fraction < 30%, and other concomitant procedures were the exclusion criteria. After this selection, we included 3,077 patients in our study. Within this group, 357 (11.6%) had been operated by residents and 2,720 (88.4%) by senior surgeons. We performed propensity score matching using the nearest neighbor method with a ratio of 1:2, considering the most important preoperative conditions. In this way, the 357 patients operated by residents were matched with the 714 patients who were operated by senior surgeons. The standardized mean differences were highly reduced after matching, so both groups had similar risk profiles. We compared surgical data, postoperative adverse events, and the 30-day mortality between the two groups.

Results The times of surgery, cardiopulmonary bypass, and cross-clamp were longer if residents operated (p < 0.001). There were no differences regarding postoperative adverse events, time of mechanical ventilation, and the intensive care unit length of stay. The 30-day mortality rates of the two groups were very similar (p = 0.75, power = 0.8).

Conclusion Training in cardiac surgery is safe, and carefully selected patients can be operated by residents without increased risk of perioperative mortality and complications.

Keywords

cardiac - heart valve surgery - coronary artery bypass grafting - CABG education, all levels


Publication History

Received: 10 February 2019

Accepted: 28 September 2019

Article published online:
26 November 2019

© 2019. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Halsband U, Lange RK. Motor learning in man: a review of functional and clinical studies. J Physiol Paris 2006; 99 (4-6): 414-424
    CrossrefPubMedSearch in Google Scholar
  • 2 Nabavi A, Schipper J. [Simulation in surgical training]. HNO 2017; 65 (01) 7-12
    CrossrefPubMedSearch in Google Scholar
  • 3 Chung RS. How much time do surgical residents need to learn operative surgery?. Am J Surg 2005; 190 (03) 351-353
    CrossrefPubMedSearch in Google Scholar
  • 4 Shapira OM, Sahar G, Raanani E. Cardiothoracic surgery training in Israel: a critical look at the past, aiming for a better future. J Thorac Cardiovasc Surg 2016; 151 (06) 1508-1515
    CrossrefPubMedSearch in Google Scholar
  • 5 Tchantchaleishvili V, Barrus B, Knight PA, Jones CE, Watson TJ, Hicks GL. Six-year integrated cardiothoracic surgery residency applicants: characteristics, expectations, and concerns. J Thorac Cardiovasc Surg 2013; 146 (04) 753-758
    CrossrefPubMedSearch in Google Scholar
  • 6 Vien C, Boré A, Lungu O. et al. Age-related white-matter correlates of motor sequence learning and consolidation. Neurobiol Aging 2016; 48: 13-22
    CrossrefPubMedSearch in Google Scholar
  • 7 Feeney JJ, Howard Jr JH, Howard DV. Implicit learning of higher order sequences in middle age. Psychol Aging 2002; 17 (02) 351-355
    CrossrefPubMedSearch in Google Scholar
  • 8 Lebares CC, Guvva EV, Ascher NL, O'Sullivan PS, Harris HW, Epel ES. Burnout and stress among US surgery residents: psychological distress and resilience. J Am Coll Surg 2018; 226 (01) 80-90
    CrossrefPubMedSearch in Google Scholar
  • 9 Janko MR, Smeds MR. Burnout, depression, perceived stress, and self-efficacy in vascular surgery trainees. J Vasc Surg 2019; 69 (04) 1233-1242
    CrossrefPubMedSearch in Google Scholar
  • 10 Loubani M, Sadaba JR, Myers PO. et al. A European training system in cardiothoracic surgery: is it time?. Eur J Cardiothorac Surg 2013; 43 (02) 352-357
    CrossrefPubMedSearch in Google Scholar
  • 11 Günther S, Beckmann A, Emrich AL. et al. Modulares Curriculum 6+, Konzeption der DGTHG zur Weiter- und Fortbildung Facharzt/Fachärztin für Herzchirurgie. Z Herz Thorax Gefäßchir 2016; 30: 2-5
    CrossrefPubMedSearch in Google Scholar
  • 12 Sádaba JR, Loubani M, Salzberg SP. et al. Real life cardio-thoracic surgery training in Europe: facing the facts. Interact Cardiovasc Thorac Surg 2010; 11 (03) 243-246
    CrossrefPubMedSearch in Google Scholar
  • 13 D'Souza N, Hashimoto DA, Gurusamy K, Aggarwal R. Comparative outcomes of resident vs attending performed surgery: a systematic review and meta-analysis. J Surg Educ 2016; 73 (03) 391-399
    CrossrefPubMedSearch in Google Scholar
  • 14 Raval MV, Wang X, Cohen ME. et al. The influence of resident involvement on surgical outcomes. J Am Coll Surg 2011; 212 (05) 889-898
    CrossrefPubMedSearch in Google Scholar
  • 15 Tolis Jr G, Spencer PJ, Bloom JP. et al. Teaching operative cardiac surgery in the era of increasing patient complexity: can it still be done?. J Thorac Cardiovasc Surg 2018; 155 (05) 2058-2065
    CrossrefPubMedSearch in Google Scholar
  • 16 Billè A, Okiror L, Harrison-Phipps K, Routledge T. Does previous surgical training impact the learning curve in video-assisted thoracic surgery lobectomy for trainees?. Thorac Cardiovasc Surg 2016; 64 (04) 343-347
    PubMedSearch in Google Scholar
  • 17 Brown C, Abdelrahman T, Patel N, Thomas C, Pollitt MJ, Lewis WG. Operative learning curve trajectory in a cohort of surgical trainees. Br J Surg 2017; 104 (10) 1405-1411
    CrossrefPubMedSearch in Google Scholar
  • 18 Krishnamoorthy B, Critchley WR, Venkateswaran RV. et al. A comprehensive review on learning curve associated problems in endoscopic vein harvesting and the requirement for a standardised training programme. J Cardiothorac Surg 2016; 11: 45
    CrossrefPubMedSearch in Google Scholar
  • 19 Smith TA, Asimakopoulos G. How safe is it to train residents to perform off-pump coronary artery bypass surgery?. Interact Cardiovasc Thorac Surg 2015; 20 (05) 658-661
    CrossrefPubMedSearch in Google Scholar